Department of Orthopaedic Surgery, Naval Medical Center, San Diego, California, USA.
Arthroscopy. 2012 Jan;28(1):43-51. doi: 10.1016/j.arthro.2011.07.002. Epub 2011 Oct 5.
To document outcomes after anterior capsulolabral reconstruction for recurrent shoulder instability in 15 patients (20 shoulders) who have had multiple failed stabilizations or collagen disorders.
Twenty shoulders with recurrent instability underwent revision stabilization with allograft reconstruction of anterior capsulolabral structures, which re-creates the labrum and capsular ligaments. The patients comprised 3 men and 12 women (mean age, 26 years [range, 18 to 38 years]) in whom multiple prior repairs failed and who had disability from continued pain and instability. Patients could choose to undergo either arthrodesis or salvage allograft reconstruction or to live with permanent disability. Of the patients, 5 had Ehlers-Danlos syndrome whereas 10 had hyperlaxity syndromes without genetic confirmation. Failure was defined as further instability surgery. Pain, shoulder function, instability (dislocations/subluxation), and American Shoulder and Elbow Surgeons scores were documented.
At follow-up, 9 of 20 shoulders (45%) remained stable. Recurrent instability was reported in 5 shoulders (25%), but the patients chose not to undergo further surgery. In the 14 shoulders without further stabilization (nonfailures), the mean American Shoulder and Elbow Surgeons score increased 43 points at a mean of 3.8 years (range, 2 to 6 years) postoperatively (P < .05). Mean satisfaction with outcome in nonfailures was 7 of 10 points (range, 1 to 10). Six shoulders failed by progressing to instability surgery at a mean of 8.6 months (range, 2.8 to 24 months). In the 6 shoulders that failed, the mean number of prior surgeries was 8 (range, 3 to 15) compared with a mean of 4 prior surgeries (range, 1 to 16) for the 9 nonfailures.
Treating patients in whom multiple stabilizations have failed remains challenging. In our series 9 shoulders (45%) remained completely stable at 3.8 years. Recurrent instability (3 reinjuries) requiring further stabilization occurred in 6 (30%). Subsequent treatment for non-instability reasons was performed in 3 (15%). Instability was reported but revision surgery was not performed in 5 (25%). In 8 nonfailures (64%), the patients were highly satisfied with their surgical outcomes. Our results support this salvage procedure as a viable alternative to arthrodesis in young patients with end-stage shoulder instability or collagen disorders.
Level IV, therapeutic case series.
为 15 例（20 肩）复发性肩关节不稳定患者记录前路囊状唇重建的结果，这些患者曾多次进行过失败的稳定或胶原疾病治疗。
20 例肩关节不稳定患者行同种异体重建前路囊状唇结构的翻修稳定术，该手术重建了唇和囊状韧带。患者包括 3 名男性和 12 名女性（平均年龄 26 岁[范围 18 至 38 岁]），他们之前的多次修复均失败，且持续疼痛和不稳定导致残疾。患者可以选择进行融合术或同种异体重建挽救治疗，或者接受永久性残疾。其中 5 例患者患有埃勒斯-当洛斯综合征，10 例患者患有高张力综合征但未经基因证实。失败定义为进一步的不稳定手术。记录疼痛、肩部功能、不稳定（脱位/半脱位）和美国肩肘外科医生评分。
随访时，20 例肩关节中有 9 例（45%）保持稳定。5 例（25%）肩关节报告复发不稳定，但患者选择不进行进一步手术。在 14 例未进一步稳定（未失败）的肩关节中，术后平均美国肩肘外科医生评分提高了 43 分，平均随访时间为 3.8 年（范围 2 至 6 年）（P<.05）。未失败的患者中，平均满意度为 7 分（范围 1 至 10 分）。6 例肩关节因进展为不稳定手术而失败，平均时间为 8.6 个月（范围 2.8 至 24 个月）。在 6 例失败的肩关节中，平均手术次数为 8 次（范围 3 至 15 次），而 9 例未失败的肩关节中，平均手术次数为 4 次（范围 1 至 16 次）。
治疗多次稳定治疗失败的患者仍然具有挑战性。在我们的系列研究中，9 例肩关节（45%）在 3.8 年后完全稳定。需要进一步稳定治疗的复发性不稳定（3 例再损伤）发生在 6 例（30%）中。由于非不稳定原因进行了后续治疗的有 3 例（15%）。5 例（25%）肩关节报告复发不稳定，但未进行修复手术。8 例（64%）非失败患者对手术结果非常满意。我们的结果支持这种挽救手术作为年轻患者终末期肩关节不稳定或胶原疾病的融合术的可行替代方案。
IV 级，治疗性病例系列研究。
